管状肠外瘘的分期和影像学表现

Image Appearance and Staging of Tubular Enterocutaneous Fistulas

目的对管状肠外瘘进行分期并探讨影像学表现。资料与方法对518例管状肠外瘘分别实施瘘管造影、口服造影、置管造影和CT检查。根据病程和瘘管情况,将管状肠外瘘分为瘘管形成期、成熟期和闭合期。结果瘘管形成期的影像学表现以炎症为主;成熟期是管状肠外瘘持续时间最长的一期,可见到各种形态的瘘管;闭合期瘘管的内口封闭,管腔逐渐消失。腹腔脓肿和腹膜后脓肿发生率与瘘管分期有非常显著的关系(P<0.005),在瘘管形成期腹腔脓肿发生率最高,而腹膜后脓肿多见于瘘管成熟期。结论瘘管分期与局部炎症的发展有密切的关系。在瘘管形成期和闭合期多用CT检查观察病情,而瘘管成熟期和闭合期,瘘管造影可对瘘管进行准确分辨。

Objective To stage the tubular enterocutaneous fistulas and discuss its image appearance. Materials and Methods The fistulography, peroral contrast, canula contrast and compute tomography （CT） were performed on 518 patients with tubular enterocutaneous fistulas. According to the course of the disease and the status of fistulas, the tubular enterocutaneous fistulas can be divided into three stages, the forming stage, the maturating stage and the closing stage. Results The main appearance of fistulas forming stage was inflammation. The longest stage was the maturating stage. The different shapes of fistulas can be seen on the maturating stage. On the closing stage, ento - aperture was closed. The lumens disappeared gradually. There was close relationship between the fistulas staging and the occurrence of celiac and retroperitoneal abscess （ P 〈 0. 005 ）. On the forming stage, the occurrence of celiac abscess was the highest, and on the maturating stage, retroperitoneal abscess was more common. Conclusion There is a close relationship between the fistulas staging and local inflammation progressing. CT is often used on the forming stage and the closing stage. The fistulngraphy can identify fistulas truly on the maturating stage and the closing stage.